Sri Lanka’s first heart transplant for a new life

It’s been four weeks since a team of senior doctors from Sri Lanka made medical history, by performing the first ever heart transplant in the country, 50 years after the world’s first cardiac transplant in 1967.

However, if not for the painstaking dedication of one person, this historical event would not have been possible this soon. Dr. Anil Abeywickrama who gave leadership to the entire mission, since the setting up of the Sri Lanka Society for Heart and Lung Transplantation, said they have opened up the path to cardiac transplants in Sri Lanka, giving new hope of life to local patients with end stage heart failure.

The Kandy Teaching Hospital where the first heart transplant took place, is currently gearing up to perform its first lung transplant, hopefully by next year, Dr. Abeywickrama disclosed in an interview with the Sunday Observer last week.

Q: It has been four weeks since Sri Lanka’s first successful heart transplant. Could you update us on the present condition of the patient who was the lucky beneficiary? Has she passed the critical phase now and is she out of danger?

A:The patient is out of danger now, she is ready to be discharged. Her stay in hospital was long because, the muscles in her limbs had to be strengthened through exercises. Her heart condition did not allow her to walk and she was bedridden for weeks prior to her surgery rendering her leg muscles to weaken.

Her heart function was only 10%. She was reaching the end of her life journey. Within the next 12 months she had a 60 % probability of mortality.

Soon after the surgery she recovered very well. She is now walking around, climbing steps and has reverted to a normal diet under close supervision by her care group including the physiotherapist.

There was no rejection in the cardiac biopsy and the heart function is perfect in the Eco Cardiogram.

Q: How promising is the future of heart transplants in Sri Lanka? How soon can we perform the next operation?

A:There are a few patients waiting for transplant in my ward at Kandy Teaching Hospital. We have all the equipment, medication and the trained personnel to perform such surgeries now but these types of complicated surgeries cannot be made on a schedule, everything depends on the organ donor.

And also it is necessary to maintain a proper registry of patients in waiting because when a potential donor, (a brain dead person) is available we can start matching the organ and the patient.

Q: It is indeed a landmark in the country’s medical history, why did it take so longas 50 years to perform a heart transplant in Sri Lanka?

A:The world’s first heart transplant was in 1967. When you compare a heart transplant with other types of similar surgeries, this involves a lot of ethical, moral and legal issues.

It is not like a normal cardiac surgery. A very complex mechanism is involved here since the donor is always a deceased person. The other issue is that Sri Lanka did not have trained clinical staff.

I have had prior experience in the mechanism of human heart and lung transplant. The entire team of doctors who took part in this landmark mission was selected by me. The doctors at the Freeman Hospital with whom I worked with before said that I had to understand everything, not just the surgical part of the operation.

Q: Can you explain how the groundwork for the first transplant was laid?

A: There are only five centres doing cardiac transplants in the UK. I had the rare opportunity to get my training at the Freeman Hospital, a leading centre in Cardiopulmonary transplant. Later I was involved as a member in a transplant team there in 2013. The International Society for Heart and Lung Transplantation sets down the guidelines and the protocol for such surgeries in the world.

Three former presidents of the International Society for Heart and Lung Transplant including Prof. Stephen Schueler, Prof. Paul Corris and Prof. John Dark and the current president Prof. Andrew Fisher are involved in the Sri Lankan program.

During my training and work at the Freeman Hospital, UK I discussed at length on how to set up a heart and lung centre in another country with Prof. Stephen Clark, Consultant Cardiothoracic Surgeon and the Director of Cardiopulmonary Transplant at the Freeman Hospital.

I am certain that without this international collaboration the entire transplant operation would not have been a success.

The former Health Services Director General Dr.Palitha Mahipala and the Attorney General Yuwanjana Wanasundera and the present AG Jayantha Jayasuriya helped bring in amendments to the Tissue Act to facilitate heart and lung transplant here. Prof. Clark held discussions with them during his visit to Colombo in 2015.

In 2015 Sri Lanka Society for Heart and Lung Transplantation was set up under the aegis of the College of Surgeons of Sri Lanka in preparation for the event.

Prof. Clark visited the country to patronize the historic event and acted as the President of the Sri Lankan Society.

Q: Could you tell us a bit more about the team who was involved in this mission, how the team of doctors for the surgery was hand-picked? Why did you choose the Kandy General hospital?

A:Dr.Kanchana Singappuli, a Pediatric Cardiac Surgeon at Lady Ridgeway Hospital, Dr. Waruna Karunaratne, Cardic Thoracic Surgeon of the Welisara Chest Hospital were involved in the entire transplant program from the beginning.

Following discussions with the Kandy Teaching Hospital Director and the Health Services DG, I was able to obtain permission to form a transplant unit at the Kandy Hospital, thus allowing clinicians from other hospitals to take part.

The reason why I chose the Kandy hospital to perform the surgery is that it had an excellent anesthetist team headed by Consultant Anesthetist Jagathi Perera with Aruni Jayasekera and Priyantha Dissanayake. Director, Kandy Hospital, Saman Ratnayake facilitated the entire operation.

There was another reason why I selected that hospital, is because of the faith I had in Consultant Neurosurgeon Dr. Leslie Siriwardena, Consultant Neuro Anesthetists Dr. Ravi Weerakoon and Dr.Udaya Karunaratne.

Q: Who funded the surgery and how much did it cost?

A:If we were to get the funding from the central government, it would have involved a complex process.

Therefore we got down instruments from other hospitals, I would say it was mainly funded by the Kandy Teaching Hospital Director Dr. Saman Ratnayake.

I went to India to get down some of the medication needed, because if we had to go through the normal procedure it would have taken a long time.

Q: What was the process to harvest the heart from the donor - the accident victim?

A:In a bypass surgery, since small vessels are involved, it becomes a very delicate operation. But here only the large arteries will be removed along with the heart. Dr. K. Gnanakanthan, Dr. Muditha Lansakkara and I were involved in that. I harvested the donor heart, and they were involved in extracting the recipient’s heart.

Kidney and Liver Transplant surgeon at Kandy hospital Dr.P.K.Harischandra harvested the kidneys from the diseased donor. Even a moment’s delay counted because harvesting of an organ for a transplant of this nature is a very complex procedure. We had to complete the transplant within three hours. Otherwise the proper function of the heart will not be there.

The recipient’s and donor’s operations were performed in Kandy Hospital, in two adjoining operating theatres.

At first I had my doubts in harvesting the particular heart. Usually a heart is extracted for donation from a patient who is declared brain dead in not more than three days.

This particular donor had been brain dead for 11 days. The heart had also suffered cardiac arrest once. But we finally went ahead with the operation and it was a big success. We are thrilled to see the results.

Q: The news of state hospitals having the capacity to undertake such complicated surgeries is indeed a good news for local heart patients whose only hope is a transplant. Does this mean the Sri Lankan private hospitals will also perform transplants in the near future?

A:The subject of heart transplants is a very sensitive issue. Considering that organ trafficking is a serious threat in this part of the world, I would not recommend it…this subject involves moral issues as well.

My personal opinion is that this should be highly regulated through state supervision and should not allowed to be commercialised. Even in the UK there are only five Cardiopulmonary Centres. I believe Sri Lanka should have only one national centre.

Q: Can Sri Lanka start its own lung transplants in the near future, if yes, how soon?

A:In cardiopulmonary centres in the world, they do both heart and lung transplant. So I am trained in lung transplant as well. We have equipped the Kandy centre for heart and lung transplants together and hopefully by next year we might commence lung transplants.

With the collaboration of the UK centre we have performed a heart surgery to the international standards. At present this is the only Cardiac transplant centre in Sri Lanka.

The surgeries performed here are free of charge. I would like to ask the patients who are in end stage heart or lung failure to get registered here. If we have a group of recipients it is easy to match a donor.

Likewise, we would want the anesthetists in Intensive Care Units to diagnose irreversible brain damaged patients early and get in touch with this centre so as to help more patients to live.